| Objective To investigate the effect of intestinal decompression drainage on the prognosis of children undergoing small intestinal anastomosis.Methods A retrospective analysis was performed for the clinical data of 47 children(50 operations)who were admitted to our hospital from January 2013 to January 2018 and underwent small intestinal anastomosis.The clinical data of 47 children(50 times of operation)were analyzed retrospectively.According to the different operations,the children were divided into two groups: the observation group was treated with the intestinal decompression drainage tube after enteroenterectomy.The control group were only performed enteroenterectomy.The operation time,the time of first defecation,the time of eating,the time of hospitalization and the incidence of complications were compared between the two groups.To investigate the feasibility of ascending colon ileum tube in retaining ileocecum and the application of small intestine tube decompression in the secondary operation of acute abdomen after small intestinal anastomosis.Results1.The clinical data of 47 sick children(50 operations)were analyzed and divided into two groups: 21 cases in the observation group and 29 cases in the contrast group.There were 15 males and 6 females with an average age of 62 days in the observation group,while 21 males and 8 females with an average age of 65 days in the contrast group.The anastomotic orifice of the observation group was located in 2 cases of Jejunum,19 cases of ileum,while 3 cases of Jejunum,26 cases of ileum in contrast group.There were 12 cases of intestinal atresia,9 cases of NEC ileostomy,18 cases of primary operation and 3 cases of secondary operation in the observation group.In the contrast group,there were 17 cases of intestinal atresia,12 cases of NEC ileostomy,29 cases of primary operation and no secondary operation.There was no significant difference in sex,anastomotic site and cause of operation between the two groups(P> 0.05),but there was no significant difference between the two groups(p > 0.05).2.Terminal ileoileostomy with the placement of a drainage tube can save the adjacent ileocecal vaIve with no leakage.The tube was inserted from ascending colon through orifice of ileocecal valve and anastomosis to ileum.3.All children underwent successful surgerys,and the gastric tube was removed on day 2 after defecation without abdominal distension.All children in observation group exhausted and defecated through drainage tube at 1~3 days after surgery.The drainage tube was removed 7~10 days after operation in all the other cases with the exception of 1 case of high jejunal atresia,the drainage tube was removed 2 weeks after operation,.After 1~3 days’ observation,children were discharged if they defecated well and had semi-liquid diet without abdominal distention or fistula orifice leakage.The comparison in time of operation between the observation group and contrast group(97.95±26.84 vs 105.56±30.53 min)was no significant difference(P>0.05).While there were significant difference in time to first postoperative defecation(5.95±1.96 vs 3.56±1.58 days),time to diet(6.95±1.96 vs 4.61±1.50 days),and length of hospital stay(15.32±5.60 vs 11±1.97 days),(t=4.60 and 4.59,t’=3.84,P<0.05).There was one case of intestinal obstruction,one case of fistula orifice leakage and one case of incision infection after operation in the observation group,and 9 cases of intestinal obstruction,2 cases of incision infection and 1 case of enteritis after operation in the contrast group.There was also a significant difference in the incidence rate of complications between the observation group and contrast group [3(14.29%)vs 12(41.37%)cases)],(χ2=4.258,P<0.05).4.No secondary operation was found in the observation group,and 3 children in the contrast group underwent secondary operation due to intestinal obstruction.The causes of intestinal obstruction were adhesion and folding around the anastomotic orifice,with 1 case of perforation at the proximal end and 1 case of transverse colon stenosis.After the treatment of the related lesions,the small intestine drainage was used.The original proximal perforation of the anastomotic orifice was used to put the drainage tube.The other two cases’ drainage tube were placed at the 5~10cm near the ileal anastomosis into subterminal intestinal cavity,and the tube was removed 10 days after the recovery of intestinal function,that is,on the 14 th day after the operation.All 3 children recovered smoothly.The children were followed up for 4 months to 5 years,and no complications,such as anastomotic stenosis,anastomotic leak,and volvulus,were observed.Conclusion 1.Intestinal decompression drainage is safe and effective in children undergoing small intestinal anastomosis and helps to reduce time to first postoperative defecation,time to diet,length of hospital stay,and incidence rate of postoperative complications.Intestinal decompression drainage is worthy of reference.2.For the children with lesion close to ileocecum,the end-to-end anastomosis can be performed with the use of drainage tube,which could keep more intestine and retain the ileocecum at the same time.It is of great significance for the preservation of normal intestinal tract structure and the full absorption of nutrients in sick children.3.In the case of intestinal obstruction,intestinal perforation or colon lesion after onestage intestinal resection and anastomosis,the drainage tube near the anastomosis provides a way of treatment for the second operation. |
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